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Biomedical subjects

E Wirfält

Publications and source records attributed to E Wirfält.

17 recordsLinked to original sources
PubMed2005

Long-term weight change and breast cancer risk: the European prospective investigation into cancer and nutrition (EPIC).

We examined prospectively the association between weight change during adulthood and breast cancer risk, using data on 1358 incident cases that developed during 5.8 years of follow-up among 40,429 premenopausal and 57,923 postmenopausal women from six European countries, taking part in the European prospective investigation into cancer and nutrition study. Multivariate Cox regression models were used to calculate hazard ratios according to weight change (kg), defined as the weight difference between age at enrollment and age 20 adjusted for other risk factors. Changes in weight were not associated with premenopausal breast cancer risk. In postmenopausal women, weight gain was positively associated with breast cancer risk only among noncurrent hormone replacement therapy (HRT) users (P-trend < or = 0.0002). Compared to women with a stable weight (+/-2 kg), the relative risk for women who gained 15-20 kg was 1.50 (95% confidence interval (CI) 1.06-2.13). The pooled RR per weight gain increment of 5 kg was 1.08 (95% CI 1.04-1.12). Weight gain was not associated with breast cancer risk in current HRT users, although, overall, these women experienced a much higher risk of breast cancer compared with nonusers. Our findings suggest that large adult weight gain was a significant predictor of breast cancer in postmenopausal women not taking exogenous hormones.

Adult↗
PubMed2004

Intakes of plant foods, fibre and fat and risk of breast cancer--a prospective study in the Malmö Diet and Cancer cohort.

The objective of this study was to investigate prospectively the associations between intakes of plant foods, fibre and relative fat and risk of breast cancer in a subsample of 11 726 postmenopausal women in the Malmö Diet and Cancer cohort. Data were obtained by an interview-based diet history method, a structured questionnaire, anthropometrical measurements and national and regional cancer registries. During 89 602 person-years of follow-up, 342 incident cases were documented. Cox regression analysis examined breast cancer risks adjusted for potential confounders. High fibre intakes were associated with a lower risk of postmenopausal breast cancer, incidence rate ratio=0.58, 95% CI: 0.40, 0.84, for the highest quintile of fibre intake compared to the lowest quintile. The combination high fibre-low fat had the lowest risk when examining the effect in each cell of cross-classified tertiles of fibre and fat intakes. An interaction (P=0.049) was found between fibre- and fat-tertiles. There was no significant association between breast cancer risk and intakes of any of the plant food subgroups. These findings support the hypothesis that a dietary pattern characterised by high fibre and low fat intakes is associated with a lower risk of postmenopausal breast cancer.

Aged↗
PubMed2004

No relations between breast cancer risk and fatty acids of erythrocyte membranes in postmenopausal women of the Malmö Diet Cancer cohort (Sweden).

OBJECTIVE: To examine the fatty acid composition of erythrocyte membranes, in relation to obesity indexes and breast cancer risk. DESIGN: A nested case-control study. SETTING: The Malmö Diet Cancer cohort, Sweden. SUBJECTS: Among women 50 y or older at baseline (n=12 803), incident breast cancer cases (n=237) were matched to controls (n=673) on age and screening date. METHODS: A diet history method, a structured questionnaire, anthropometrics and blood samples provided data. Analysis included partial correlation coefficients between dietary fatty acids (DFA) and fatty acids of erythrocyte membranes (EFA), and Spearman's rank order correlations between EFA and four obesity indexes. Conditional logistic regression examined breast cancer risks related to EFA. RESULTS: DFA and EFA from fish and milk, and DFA and EFA linoleic acid, show significant positive associations. Relations are negative between indexes of obesity and "milk" EFA, but positive between indexes of obesity and indexes of delta9- and delta6-desaturase enzyme activity. No significant relations were observed between EFA and breast cancer risk. CONCLUSIONS: Similar to other studies, dietary fish and milk fatty acids, and linoleic acid, are related to the corresponding EFA. Breast cancer risk was not significantly related to EFA in this study. However, the findings suggest positive relations between body mass index, body fat per cent and indexes of desaturase activity, and negative relations between central obesity and milk EFA. SPONSORSHIP: The Swedish Cancer Society, the Swedish Medical Research Council, the European Commission, the Swedish Dairy Association and the City of Malmö.

Animals↗
PubMed2002

Food sources of carbohydrates in a European cohort of adults.

OBJECTIVE: To describe the average consumption of carbohydrate-providing food groups among study centres of the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS: Of the 27 redefined EPIC study centres, 19 contributed subjects of both genders and eight centres female participants only (men, women, after exclusion of subjects under 35 and over 74 years of age from the original 36 900 total). Dietary data were obtained using the 24-hour recall methodology using the EPIC-SOFT software. The major sources of dietary carbohydrate were identified, and 16 food groups were examined. RESULTS: The 10 food groups contributing most carbohydrate were bread; fruit; milk and milk products; sweet buns, cakes and pies; potato; sugar and jam; pasta and rice; vegetables and legumes; crispbread; and fruit and vegetable juices. Consumption of fruits as well as vegetables and legumes was higher in southern compared with northern centres, while soft drinks consumption was higher in the north. Italian centres had high pasta and rice consumption, but breakfast cereal, potato, and sweet buns, cakes and pies were higher in northern centres. In Sweden, lower bread consumption was balanced with a higher consumption of crispbread, and with sweet buns, cakes and pies. Overall, men consumed higher amounts of vegetables and legumes, bread, soft drinks, potatoes, pasta and rice, breakfast cereal and sugar and jam than women, but fruit consumption appeared more frequent in women. CONCLUSION: The study supports the established idea that carbohydrate-rich foods chosen in northern Europe are different from those in the Mediterranean region. When comparing and interpreting diet-disease relationships across populations, researchers need to consider all types of foods.

Adult↗
PubMed2002

Diversity of dietary patterns observed in the European Prospective Investigation into Cancer and Nutrition (EPIC) project.

OBJECTIVE: To describe the diversity in dietary patterns existing across centres/regions participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). DESIGN AND SETTING: Single 24-hour dietary recall measurements were obtained by means of standardised face-to-face interviews using the EPIC-SOFT software. These have been used to present a graphic multi-dimensional comparison of the adjusted mean consumption of 22 food groups. SUBJECTS: In total, 35 955 men and women, aged 35-74 years, participating in the EPIC nested calibration study. RESULTS: Although wide differences were observed across centres, the countries participating in EPIC are characterised by specific dietary patterns. Overall, Italy and Greece have a dietary pattern characterised by plant foods (except potatoes) and a lower consumption of animal and processed foods, compared with the other EPIC countries. France and particularly Spain have more heterogeneous dietary patterns, with a relatively high consumption of both plant foods and animal products. Apart from characteristics specific to vegetarian groups, the UK 'health-conscious' group shares with the UK general population a relatively high consumption of tea, sauces, cakes, soft drinks (women), margarine and butter. In contrast, the diet in the Nordic countries, The Netherlands, Germany and the UK general population is relatively high in potatoes and animal, processed and sweetened/refined foods, with proportions varying across countries/centres. In these countries, consumption of vegetables and fruit is similar to, or below, the overall EPIC means, and is low for legumes and vegetable oils. Overall, dietary patterns were similar for men and women, although there were large gender differences for certain food groups. CONCLUSIONS: There are considerable differences in food group consumption and dietary patterns among the EPIC study populations. This large heterogeneity should be an advantage when investigating the relationship between diet and cancer and formulating new aetiological hypotheses related to dietary patterns and disease.

Adult↗
PubMed2001

Food patterns and components of the metabolic syndrome in men and women: a cross-sectional study within the Malmö Diet and Cancer cohort.

This study examined the relations between food patterns and five components of the metabolic syndrome in a sample of Swedish men (n = 2,040) and women (n = 2,959) aged 45-68 years who joined the Malmö Diet and Cancer study from November 1991 to February 1994. Baseline examinations included an interview-administered diet history, a self-administered questionnaire, blood pressure and anthropologic measurements, and blood samples donated after an overnight fast. Cluster analysis identified six food patterns for which 43 food group variables were used. Logistic regression analysis was used to examine the risk of each component (hyperinsulinemia, hyperglycemia, hypertension, dyslipidemia, and central obesity) and food patterns, controlling for potential confounders. The study demonstrated relations, independent of specific nutrients, between food patterns and hyperglycemia and central obesity in men and hyperinsulinemia in women. Food patterns dominated by fiber bread provided favorable effects, while food patterns high in refined bread or in cheese, cake, and alcoholic beverages contributed adverse effects. In women, food patterns dominated by milk-fat-based spread showed protective relations with hyperinsulinemia. Relations between risk factors and food patterns may partly depend on gender differences in metabolism or food consumption and on variations in confounders across food patterns.

Adipose Tissue↗
PubMed2001

Fat intake is more strongly associated with lifestyle factors than with socio-economic characteristics, regardless of energy adjustment approach.

OBJECTIVE: To compare how three different energy adjustment approaches influence the ranking of individuals on fat intake, and to examine the relation between fat intake and socio-economic, demographic and lifestyle characteristics for each energy adjustment approach. DESIGN: A cross-sectional analysis project, using a sub-sample (7055 women and 3240 men) from the Malmö Diet and Cancer Study. Dietary habits were assessed with an interview based diet history method. Fat intake was, depending on energy-adjustment method, defined as absolute intake (FATg), percentage energy from fat (FAT%), and residuals from total fat regressed on total energy (FATres). Cross-classification compared categorisation into fat intake quintiles. Logistic regression estimated, separately for each of the three approaches, the associations between high fat intake and socio-economic, demographic and lifestyle characteristics. RESULTS: Agreement in individuals' ranking was high between FAT% and FATres, but FATg differed substantially from the others. Current smoking, low level of leisure time physical activity and low alcohol intakes were, in multivariate analysis, consistently associated with risk of high fat consumption regardless of energy adjustment method. However, the associations with socio-economic characteristics varied with energy adjustment method and gender groups. CONCLUSIONS: The similarities between FAT% and FATres, in the ranking of individuals and in the association with lifestyle factors and socio-economic characteristics implies that it is possible to translate results obtained with FATres to recommendations using FAT%. The consistent lifestyle pattern across fat intake definitions (in energy adjusted models) may indicate that fat consumption is more strongly related to lifestyle factors than to socio-economic characteristics.

Aged↗
PubMed2001

Serum concentrations of beta-carotene and alpha-tocopherol are associated with diet, smoking, and general and central adiposity.

BACKGROUND: Previous studies of associations between diet, obesity, and blood concentrations of alpha-tocopherol and beta-carotene have been equivocal. Furthermore, most studies used only body mass index (BMI) as an obesity measure. OBJECTIVES: Our objectives were to examine the associations between energy and nutrient intakes, alcohol consumption, tobacco use, and serum cholesterol and serum concentrations of alpha-tocopherol and beta-carotene, and to examine the associations between different measures of general and central adiposity and serum concentrations of alpha-tocopherol and beta-carotene. DESIGN: This was a cross-sectional, population-based study of 253 men and 276 women aged 46-67 y. Nutrient data were collected by a modified diet history method. Measures of obesity included BMI, percentage of body fat (impedance analysis), waist-to-hip ratio, and waist circumference. The associations between serum nutrient concentrations and the other factors were examined by multiple linear regression. RESULTS: Twenty-one percent of men and 34% of women used antioxidant supplements. The mean BMI was 26.1 in men and 25.4 in women. Serum beta-carotene concentration was positively associated with serum cholesterol concentration, fiber intake, and beta-carotene intake, and negatively associated with smoking and all measures of obesity. In men, serum beta-carotene concentration was not significantly associated with central adiposity after adjustment for body fat. Serum alpha-tocopherol concentration was positively correlated with serum cholesterol, obesity, and vitamin E intake. In women, serum alpha-tocopherol concentration was also positively associated with intakes of ascorbic acid and selenium. Serum alpha-tocopherol concentration was associated with central adiposity after adjustment for body fat. CONCLUSION: Serum beta-carotene and alpha-tocopherol concentrations have different associations with diet, smoking, general adiposity, and central adiposity.

Adipose Tissue↗
PubMed2001

Socioeconomic differences in the consumption of vegetables, fruit and fruit juices. The influence of psychosocial factors.

BACKGROUND: The aim was to investigate whether social network and social support factors can explain socioeconomic differences in the risk of consuming low amounts of vegetables, fruit and fruit juices. METHODS: The Malmö Diet and Cancer Study was a prospective cohort study. The present cross-sectional study examined data from a subpopulation of 11,837 individuals that completed baseline examinations in 1992-1994. Dietary habits were assessed using a modified diet history method, and socioeconomic and social network factors were measured with a structured questionnaire. Low consumption was defined as the lowest consumption quartile for vegetables and fruit, while fruit juice consumption was dichotomized to separate users from non-users. RESULTS: Socioeconomic differences were most pronounced regarding the consumption of vegetables and fruit juices. For both sexes, unskilled manual workers had a twice as high risk of low vegetable and fruit juice consumption as higher non-manual employees. No socioeconomic differences in fruit consumption were observed for men, and only moderate differences for women with a higher consumption in higher socioeconomic groups. When the psychosocial variables were introduced in the multivariate model, social participation moderately reduced the socioeconomic differences in vegetable consumption, and the female socioeconomic differences in fruit consumption, but had no effect on the socioeconomic differences in fruit juice consumption. The other psychosocial variables had no effect on the socioeconomic differences. CONCLUSION: Considerable socioeconomic differences in vegetable, fruit and fruit juice consumption were observed. Social participation seemed to be a strong determinant for these food choices. However, this effect was largely independent of the socioeconomic differences.

Beverages↗
PubMed2000

Self-administered questionnaire compared with a personal diary for assessment of current use of hormone therapy: an analysis of 16,060 women.

A personal diary may be more appropriate than a questionnaire for assessing self-reported current use of hormone therapy (estrogens, progestagens, or their combination); however, use of a questionnaire is more feasible and less expensive. The authors compared both methods for 16,060 Swedish women aged 45-73 years from the Malmo Diet and Cancer Study (baseline, 1991-1996). In a reliability analysis, the authors investigated the agreement (kappa value) between the questionnaire and the diary regarding current hormone therapy use (yes vs. no), studying the ability to replicate results whether or not they were correct. They also explored associations between discrepancy and individual characteristics. A validity analysis was conducted to determine whether use of the questionnaire achieved an outcome without systematic error (i.e., high specificity and sensitivity); the personal diary was considered the "gold standard." Agreement between both methods was high: 95.5% (kappa = 0.840). The sensitivity was 84.9% and the specificity 97.7%. Higher body mass index and being a widow were associated with agreement, whereas age (50-59 years), use of anxiolytics/hypnotics or opiates, high alcohol consumption, past smoking, and higher educational level were associated with discrepancy. Compared with a personal diary, a simple self-administered questionnaire is a valid method for assessing current use of hormone therapy.

Aged↗
PubMed2000

Food patterns defined by cluster analysis and their utility as dietary exposure variables: a report from the Malmö Diet and Cancer Study.

OBJECTIVE: To explore the utility of cluster analysis in defining complex dietary exposures, separately with two types of variables. DESIGN: : A modified diet history method, combining a 7-day menu book and a 168-item questionnaire, assessed dietary habits. A standardized questionnaire collected information on sociodemographics, lifestyle and health history. Anthropometric information was obtained through direct measurements. The dietary information was collapsed into 43 generic food groups, and converted into variables indicating the per cent contribution of specific food groups to total energy intake. Food patterns were identified by the QUICK CLUSTER procedure in SPSS, in two separate analytical steps using unstandardized and standardized (Z-scores) clustering variables. SETTING: : The Malmö Diet and Cancer (MDC) Study, a prospective study in the third largest city of Sweden, with baseline examinations from March 1991 to October 1996. SUBJECTS: A random sample of 2206 men and 3151 women from the MDC cohort (n = 28 098). RESULTS: Both variable types produced conceptually well separated clusters, confirmed with discriminant analysis. 'Healthy' and 'less healthy' food patterns were also identified with both types of variables. However, nutrient intake differences across clusters were greater, and the distribution of the number of individuals more even, with the unstandardized variables. Logistic regression indicated higher risks of past food habit change, underreporting of energy and higher body mass index (BMI) for individuals falling into 'healthy' food pattern clusters. CONCLUSIONS: The utility in discriminating dietary exposures appears greater for unstandardized food group variables. Future studies on diet and cancer need to recognize the confounding factors associated with 'healthy' food patterns.

Aged↗
PubMed2000

Fruit and vegetable consumption in relation to risk factors for cancer: a report from the Malmö Diet and Cancer Study.

OBJECTIVE: To examine the associations between the consumption of fruit and vegetables and other markers of cancer risk. DESIGN: A cross-sectional survey within the population-based prospective Malmö Diet and Cancer (MDC) Study. Information on food habits was collected through the modified diet history method designed and validated for the MDC Study. Data on smoking and alcohol habits, leisure time physical activity, birth country, education, socioeconomic status and cohabitation status were collected through a questionnaire. SETTING: Malmö, the third largest city in Sweden. SUBJECTS: All subjects who entered the MDC Study during winter 1991 to summer 1994 (men and women living in Malmö, aged between 46 and 68 years), with a total of 15 173. RESULTS: Women consumed more fruit and vegetables than men. Low consumption of both fruits and vegetables was associated with unfavourable nutrient profiles: higher percentage of energy from fat and lower intakes of antioxidant nutrients and dietary fibre. Low consumption was also associated with smoking, low leisure time physical activity, low education and being born in Sweden. High age was associated with low vegetable consumption in both genders. CONCLUSION: This study indicates that several established risk markers and risk factors of cancer may be independently associated with low fruit and vegetable consumption. The findings suggest that the adverse effects of factors such as smoking, low physical activity and a high-fat diet could partly be explained by low consumption of fruit or vegetables. The implied health benefits of a low or moderate alcohol consumption may be similarly confounded by high consumption of fruit or vegetables.

Aged↗
PubMed2000

Socioeconomic differences in fat intake in a middle-aged population: report from the Malmö Diet and Cancer Study.

BACKGROUND: The objective was to investigate whether socioeconomic differences in fat intake may explain socioeconomic differences in cardiovascular diseases. METHODS: The Malmö Diet and Cancer Study is a prospective cohort study. The baseline examinations used in the present cross-sectional study were undertaken in 1992-1994. Dietary habits were assessed using a modified diet history method consisting of a 7-day menu book and a 168-item questionnaire. A subpopulation of 11 837 individuals born 1926-1945 was investigated. This study examined high fat intake, defined as >35.9% among men and >34.8% among women (25% quartile limit) of the proportion of the non-alcohol energy intake contributed by fat. The subfractions saturated, mono-unsaturated and poly-unsaturated fatty acids and the P:S ratio (polyunsaturated/saturated fatty acids) were analysed in the same way. The uppermost quartile (75%) of total and subgroup fat intake was also studied. Socioeconomic differences before and after adjustment for low energy reporting (LER), defined as energy intake below 1.2 x Basal Metabolic Rate, were examined. RESULTS: No socioeconomic differences in fat intake were seen between the SES groups, except for self-employed men, and male and female pensioners. Approximately 20% in most SES groups were LER. The LER and body mass index were strongly related. The SES pattern of fat intake remained unchanged after adjustment for age, country of origin and LER in a logistic regression model. The results for the subfractions of fat and the P:S ratio did not principally differ from the total fat results. CONCLUSIONS: This study provides no evidence that fat intake contributes to the inverse socioeconomic differences in cardiovascular diseases.

Body Mass Index↗
PubMed2000

Beliefs concerning dietary practices during pregnancy and lactation. A qualitative study among Iranian women residing in Sweden.

Growing multiculturalism in Sweden challenges health professionals to provide safe and culturally meaningful care. Differences between the health--disease explanatory models of lay persons and health professionals may lead to communication problems, which ultimately could affect health outcomes. The aim of this study was to explore beliefs about food and health during pregnancy and lactation. Increased knowledge and understanding among health professionals on such issues should facilitate culturally congruent nutrition counselling. Individual interviews were performed among first-generation Iranian female immigrants in the county of Stockholm. The interviews followed a set of predefined key questions. Content analysis of interview transcripts followed a grounded theory approach. Five major categories emerged, which referred to 'hot-cold' values, foetal attributes, satisfaction of cravings, survival of the mother, and quantity and quality of breast milk. 'Mother's diet provides strength that sustains life' emerged as the most relevant core concept. This study demonstrated maternal strength to be important for a successful pregnancy outcome and lactation. Displacement of food items caused by migration in combination with a strong adherence to Iranian health beliefs could potentially cause food choices with detrimental health effects.

Culture↗
PubMed1988

Mapping of the "intervention channels" as a part of the community diagnosis process of the Stockholm Cancer Prevention Program (SCPP).

The Stockholm Cancer Prevention Program is to our knowledge the first community intervention program in the world aiming of a reduction in the incidence of cancer. A community diagnosis model has been used in the planning. A thorough description of different organizations in the local communities of Stockholm has been made. A model for describing the organizations or collaborators has been worked out, including description of the organizations and its environment, objectives of activities, possible activities to reach the objectives, resources needed, incentives for collaborative partners, formative evaluation criteria and anticipated problems and solutions. The main method of description has been by use of keyperson interviews. This was found to be a good method to reach commitment to the program.

Community Health Services↗